title: Impetigo in a population over 8.5 years: incidence, fusidic acid resistance and molecular characteristics.
abstract: OBJECTIVE
  From around year 2000, impetigo caused by fusidic acid-resistant Staphylococcus aureus was observed in countries of Northern Europe. The bacteria were found to represent a clone, the epidemic European fusidic acid-resistant impetigo clone (EEFIC). This study reports longitudinal data on the incidence and bacteriology of impetigo in a Norwegian island community during the years 2001-09.
  
  
  METHODS
  All encounters with general practitioners regarding impetigo were registered. Bacterial swabs were taken in a high percentage of cases. Annual incidence was calculated. Phenotypic characteristics of the bacteria were determined for the whole period, and in 2008 and 2009 we also performed PFGE and spa typing.
  
  
  RESULTS
  Outbreaks of impetigo were observed in 2002, 2003 and 2004, but since then the incidence decreased greatly. S. aureus was cultured from the impetigo site in the majority of cases. The proportion of S. aureus isolates resistant to fusidic acid decreased from 80% in 2002-04 to 45% in 2008-09. For 28 S. aureus isolates analysed by molecular methods in 2008-09, we found that nearly all cases of fusidic acid resistance were due to the presence of the EEFIC.
  
  
  CONCLUSIONS
  S. aureus resistance to fusidic acid in relation to impetigo is now less frequent in this population than at the start of the century. At present, most S. aureus bacteria resistant to fusidic acid in impetigo belong to the EEFIC.
authors.affiliation: Municipal Health Services of Austevoll, Bekkjarvik, Norway. sverre.rortveit@aknett.net
authors.forename: Sverre
authors.initials: S
authors.lastname: Rørtveit
authors.forename: Dag Harald
authors.initials: DH
authors.lastname: Skutlaberg
authors.forename: Nina
authors.initials: N
authors.lastname: Langeland
authors.forename: Guri
authors.initials: G
authors.lastname: Rortveit
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005672:Fusidic Acid / Q000494:pharmacology*; D006801:Humans; D007169:Impetigo / Q000453:epidemiology* / Q000382:microbiology; D015994:Incidence; D058889:Molecular Typing; D009664:Norway / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D005672:Fusidic Acid